Survival and durability after endovascular aneurysm repair reflect era-related surgical judgement.

OBJECTIVE: Abdominal aortic aneurysm management guidelines from the National Institute for Clinical Excellence in 2020, based heavily on randomized controlled trials in an early era of infrarenal endovascular aneurysm repair (EVAR), suggested that the long-term outcomes after EVAR jeopardize its use in elective abdominal aortic aneurysm repair. We hypothesized that, in a rapidly evolving surgical field, the era of aneurysm repair may have a significant influence on long-term patient outcomes. METHODS: Using a single-center retrospective cohort design, we identified two EVAR cohorts, the early cohort (n = 166) who underwent EVAR from 2008 to 2010, and a contemporary late cohort (n = 129) from 2015 to 2017. We assessed patient preoperative demographics and era of repair against the primary outcomes of reinterventions, reintervention-free survival, and mortality, addressing their relationships to anatomic selection criteria, graft durability, endoleak, and aneurysm diameter to 5 years after the procedure. RESULTS: Early cohort patients had decreased reintervention-free survival (early 80.1% vs late 93.3%) and decreased overall survival (early 71.3% vs late 81%) at 3 years and throughout follow-up. The preoperative anatomy judged suitable for EVAR in early cohort patients was more variable than for late cohort patients, including 104% larger proximal and 106% larger distal landing zone diameters, with a mean 11.6-mm shorter length infrarenal aortic and 13.3-mm shorter length iliac sealing zones in the early group. Early cohort patients had more complications during follow-up, including graft kinking and endoleaks, and 24.4% of early vs 8.5% of late patients underwent one or more reinterventions. CONCLUSIONS: Although technical skill in EVAR implantation may not evolve significantly after a threshold of cases, surgical judgement, relating to anatomic selection and device sizing, requires feedback from long-term sequalae and significantly impacted EVAR outcomes by era. EVAR patients from an early repair era had significantly worse outcomes, with more complications, reinterventions, and a decrease in survival.

Secure Base Priming Diminishes Conflict-Based Anger and Anxiety.

This study examines the impact of a visual representation of a secure base (i.e. a secure base prime) on attenuating experimentally produced anger and anxiety. Specifically, we examined the assuaging of negative emotions through exposure to an image of a mother-infant embrace or a heterosexual couple embracing. Subjects seated at a computer terminal rated their affect (Pre Affect) using the Affect Adjective Checklist (AAC) then listened to two sets of intense two person conflicts. After the first conflict exposure they rated affect again (Post 1 AAC). Following the second exposure they saw a blank screen (control condition), pictures of everyday objects (distraction condition) or a photo of two people embracing (Secure Base Prime condition). They then reported emotions using the Post 2 AAC. Compared to either control or distraction subjects, Secure Base Prime (SBP) subjects reported significantly less anger and anxiety. These results were then replicated using an internet sample with control, SBP and two new controls: Smiling Man (to control for expression of positive affect) and Cold Mother (an unsmiling mother with infant). The SBP amelioration of anger and anxiety was replicated with the internet sample. No control groups produced this effect, which was generated only by a combination of positive affect in a physically embracing dyad. The results are discussed in terms of attachment theory and research on spreading activation.